Pulmonology Coding Alert

Question: I know that CPT changed 94664 to demonstrate and instruct the use of bronchodilators. Our practice often reports 94664 when doing pre- and post-treatment pulmonary function tests (PFTs). Would you instruct us on how the changes will affect our reporting?

South Dakota Subscriber
 
Answer: If your physician performs a bronchospasm evaluation to determine the patient's responsiveness of treatment, you should report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post- bronchodilator administration), which includes the spirometry measurements both pre- and post- bronchodilator administration.

Carriers do not consider the cost of the bronchodilator as part of the payment for 94060. CPT suggests that you report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies or materials provided]) or the appropriate drug code. 

If you report a drug code instead, you should choose a code from HCPCS that identifies the specific drug and amount the physician administered during the evaluation. For example, if the physician administers Albuterol, you may select the most appropriate code (such as, J7613, Albuterol, inhalation solution, administered through DME, unit dose, 1 mg), depending on the specific form and dose the physician administers. 

But if the patient has an acute exacerbation of asthma (493.02, Extrinsic asthma; with [acute] exacerbation) to which the physician needs to administer a bronchodilator, you should report 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device]) in addition to the appropriate J code representing the drug.

If the physician demonstrates and/or evaluates the patient administration of the drug, you should consider the demonstration/evaluation a component of 94640. You should not report the demonstration/evaluation separately.